Multimodal diagnostic and surgical approach to spontaneous esophageal rupture induced by severe coughing: A case report.

Abstract

Background: Boerhaave syndrome, or spontaneous esophageal rupture, is a rare and life-threatening emergency, typically caused by a sudden increase in esophageal pressure due to violent coughing or vomiting. Early diagnosis is challenging as its symptoms often resemble those of other diseases. Understanding its pathological features and treatment strategies is therefore critical for clinical practice.

Case summary: This report describes a case of spontaneous esophageal rupture triggered by violent coughing in a 55-year-old male with a history of smoking and hypertension. Following severe coughing, the patient developed chest pain, vomiting, and respiratory distress. Initial clinical evaluation was inconclusive, with a suspected diagnosis of cardiovascular or gastrointestinal conditions. After further examination, the diagnosis of spontaneous esophageal rupture was confirmed. Chest X-ray, computed tomography, and endoscopy revealed a rupture in the lower esophagus, along with mediastinal abscess and pleural effusion. Laboratory tests showed mild infection markers. The patient underwent surgical repair of the esophageal rupture (approximately 3 cm in length) with mediastinal drainage. Postoperatively, the patient's temperature normalized within 3 days, respiratory function improved, and pleural effusion significantly decreased. After two weeks of treatment, the patient was discharged without complications and had a favorable prognosis. The study suggests that while violent coughing is a rare trigger, it can lead to severe damage, and imaging techniques play a crucial role in diagnosis.

Conclusion: Spontaneous esophageal rupture presents significant diagnostic and therapeutic challenges. Early recognition and timely intervention are crucial for improving prognosis. This case highlights the importance of imaging and surgical treatment, offering new insights for managing similar cases and providing valuable clinical guidance.